CERTIFICATE OF DESTRUCTION - PDF

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					                         CERTIFICATE OF DESTRUCTION

Submit to: Human Subjects Review Board, Arizona Department of Health Services
           1740 W. Adams, Room 200, Phoenix, Arizona 85007

HSRB#____________________

Name of Study___________________________________________________________

Principal Investigator:_____________________________________________________

Organization:____________________________________________________________

________________________________________________________________________

Address:________________________________________________________________

Telephone:______________________________________________________________



Type of Documents:________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Date, Time and Method of Destruction:________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________




Signature of Principal Investigator                       Date




Certdest09B